Health

Multifactorial facial pain - differential diagnosis: a case report

Article Abstract:

A multidisciplinary team was formed to diagnose and treat patients with head and neck pain. This team consisted of specialists from oral surgery, psychiatry, psychology, psychometrics, kinesiology, prosthodontics, physical therapy, orthodontics and radiology. Neurology and otolaryngology (ear,nose and throat) specialists were also available for patient evaluation. A case report is presented to illustrate how the team functioned. A 23-year-old woman complained that the sides of her face hurt all the time. She also reported organic, psychiatric and psychosocial problems. A thorough medical history and physical examination were conducted. The surgical recommendations were to correct the patient's skeletal malocclusion after treating her pain. Behavioral medicine specialists diagnosed hyperactivity of the head muscles and suggested stress management therapy. Physical therapists noted a forward head posture, restriction of neck motion and neck pain, and recommended physical therapy to improve joint movements and posture. Depression, neurotic anxiety and somatoform conversion disorder (organic symptoms caused by psychogenic factors such as depression) were diagnosed by psychiatrists who advised psychotherapy and anti-depressant medication. Psychology/psychometric specialists administered tests which also indicated acute depression/anxiety syndrome. Orthotic specialists concurred with the surgical diagnosis of jaw deformity and malocclusion and questioned the possible need for long-term stabilization of the temporomandibular joint (where the upper jaw joins the skull). Successful treatment of this patient, who had both organic and psychiatric pathology, was due to recognition of the multifactorial nature of her facial pain. (Consumer Summary produced by Reliance Medical Information, Inc.)

The role of orthognathic surgery in the treatment of severe dentoalveolar extrusion: case report

Article Abstract:

A case is reported of a 61-year-old man whose right premolars and molars in his upper jaw were extruding far below the level of the other teeth. This happened because his right premolars and molars in the lower jaw had been removed 40 years earlier but had not been replaced. This left no teeth in the bottom jaw to keep the molars in the upper jaw in their proper place. An oral surgeon placed implants in his right lower jaw to provide an opposing force and the right upper teeth were fixed later.